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Infection Control Best Practices for Home-Based Programs
“Those who bring beauty and love into the world
cannot keep it from themselves ”
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themselves…
Miranda Spindel, DVM, MSDirector of Veterinary Outreach
ASPCA
Considerations• Time commitment• Resources needed• Cleaning is hard work!• Fostering is a 24 hr job• Dealing with illness• Health risks
– Your pets
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Your pets– Family & Friends
• Emotional ups and downs
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Objectives
• Understand why homeless animals get sick
T i i i i l– Transmission principles
• Learn about routine infection control practices
– How to set up a foster home environment for success
– Preventative animal health care practices
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• Help you help more animals find lifelong homes!
Why Do These Animals Get Sick?
EnvironmentAnimals
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Disease Agents
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Environment• Overcrowding is common• Isolation/quarantine can be difficultIsolation/quarantine can be difficult• Older buildings not designed for wellness• Poor ventilation• Temperature extremes• Difficult to clean efficiently
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• Difficult to clean efficiently
Animals• Histories often unknown• Little prior preventative health careLittle prior preventative health care• Immunocompromised • Often ill on intake• Age extremes• Population always changing
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• Population always changing• Inherently stressed
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Understanding Disease• MANY causes
– Viruseso Feline Herpes Viruso Canine Influenza Virus
– Bacteriao Bordetella bronchiseptica
– Parasiteso Roundworms
Fl / i k
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o Fleas/ticks– Fungi
o Dermatophytosis
Understanding Disease• Many transmission modes and control strategies
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Detecting Disease Isn’t Easy• Infectious animals are not always obvious.
• Physical exams and lab tests may not detect or confirm disease.
• Animals can be
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• Animals can be adopted, transferred or placed into the population and later show illness
Carriers and Incubation Times
• Carrier state - an animal who is notCarrier state an animal who is not outwardly symptomatic harbors a pathogen in its body that can infect others
• Incubation period - time from exposure to
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onset of symptoms
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Examples• Feline Calici Virus
– Can be carried lifelongCan be carried lifelong– May be shed continuously
• Canine Influenza Virus– After exposure, 2-5 day incubation period
Usually 7 10 days before clinical signs
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– Usually 7-10 days before clinical signs– Peak viral shedding occurs prior to symptoms– Pneumonia can be weeks later
Shelter Holding Periods• Average incubation period for common shelter diseases is 2-15 daysy
• Average legal holding period is 5-7 days
• Many opportunities exist for incubation &
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y ppcarriage
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Understanding Disease• Shelter consequences
• Spreado Outbreakso Zoonosiso Decreased welfareo Death
• Difficult decisions
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• Difficult decisionso Treatment− Staff time, money, space
o Euthanasia
Realistic Goals
• Some illness is inevitableLi it ll di• Limit overall disease
• Prevent outbreaks• Prevent zoonosis• Aim for well animals!
EnvironmentAnimals
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Disease Agents
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Shelter Medicine 101
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“Creating wellness requires a team approach”
Population ManagementIncreased
STRESS
Behavioral
&
medical
problems
Increased
time
in
shelter
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Population Management
• Ways to decrease shelter time
• Things that increase shelter time shelter time
– Foster– Rescue– Reclaim– Transfer– Adoption
shelter time…– Holding periods– Illness– Long evaluations– Management issues– Animal flow issues
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p– Euthanasia
Animal flow issues
Home Based Programs Save Lives!
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Elements of Great Home Programs
• Dedicated coordinatorsW itt li i d d• Written policies and procedures
• Volunteer training• Animal selection and volunteer matching• Guidelines for veterinary care
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• Media/marketing for adoption
Animal Selection
• Skill of coordinator=critical to program success
• In addition to whether home is available selection criteria should consider:– Turnover time– Investment required
Ad t bilit
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– Adoptability– Health status– Behavior status
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Animal Selection• Age
– Too young/small for shelter environment– Nursing litters– Geriatric
• Health– Illness– InjuryB h i
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• Behavior– Undersocialized– Home environment needed to evaluate
Foster Home Selection• Match human interest, ability, housing capability to animals’ needsp y• Interview• Home visit• Training process/experience• Recent infectious disease in home?
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Before Animals Leave Shelter• Legal contract/written records
– Who “owns” animal– Description of animal– Who is responsible for provision of proper care
• Address animal care wellness issuesE i t l
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– Environmental– Physical– Emotional
Before Animals Enter a Home• Humans should be immunocompetent +/or
consult with their physicianAtt d ti i d ti t i i i l• Attend continuing education trainings on animal care
• Prepare for 2+ week commitment• Be able to recognize personal limits• Be able to adopt animals out
Be a are that animals ma not s r i e
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• Be aware that animals may not survive –emotionally hard
• One primary caregiver should be 18 yrs or older
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Before Animals Enter a Home• Establish a contact for health/behavior concerns• Have access to care 24 hrs/day – most emergencies are not during normal hours– Shelter staff/coordinator– Community liaison
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– Personal contact– Have information #s handy
Before Animals Enter a Home
• Animals are infectious until proven otherwiseotherwise
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Before Animals Enter a Home• Discuss resident animals’ health care with personal veterinarian– Vaccination status– Internal and external parasite control– Isolation concerns– Geriatrics– Immunocompromised animals
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– Weigh risk:benefit
Before Animals Enter a HomeComponents of Wellness
1. Environmental Health 2. Physical Health3 Emotional Health
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3. Emotional Health
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Before Animals Enter a Home
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Before Animals Enter a HomeIsolation ideals:
• Low traffic patterns• Dedicated supplies• Required protective gear• Clear signs• Well trained (separate) people
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people• Different ventilation
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Before Animals Enter a Home• Set up a small, contained area
– Bathroom, laundry room, kitchen, bedroom, y , ,o Wash-able surfaces (linoleum, tile)o No carpeto Safe o Easy to disinfecto Warm
Quiet
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o Quieto Light
– Running water/sink is ideal
Before Animals Enter a Home• Isolated from other pets in home
– Solid door/floor-ceiling walls– Ventilation/fresh air source– Ideally low human traffic area
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Before Animals Enter a Home• Dedicate foster supplies
– Shoes/clothes that stay in the roomy– Cleaning supplies– Food and water bowls– Toys– Bedding
T h
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– Trash– Medical supplies
Before Animals Enter a Home• Use supplies and materials that can be sanitized
• Disposables• Stainless steel• Non-porous plastic
• Carpet• Pebble gravel• Grass
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p p• Sealed concrete • Soil
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Before Animals Enter a Home
Be prepared for good housekeeping!
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Good Housekeeping• Infection control involves cleaning and disinfecting – they are not the same thingg y g
– Cleaning – manual removal of all dirt and organic debris from all surfaces in addition to washing with water and soap
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– Disinfecting – inactivation of the pathogen
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Good Housekeeping• Schedule for daily cleaning
– High contact surfaces (horizontal, doorknobs, g ( , ,etc)
– Visibly soiled objects/surfaces– Litterboxes, bowls
• Schedule for regular disinfectingAll f kl ( ll bli d fl t )
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– All surfaces weekly (walls, blinds, floors, toys)– Between new animals– Daily or more often when infectious disease occurs
Good Housekeeping• Hand hygiene
1. Before and after handling animals
2. After contact with items in animals’ environment
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Good Housekeeping•What supplies to have on hand?
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Disinfectants for Home• Sodium hypochlorite
(regular household 5% bleach)– 1:32 – ½ cup/gallon
1:10 1 ½ cup/gallon– 1:10 – 1 ½ cup/gallon
– Studies show 1:32 reliably kills parvo, calici– 1:10 for ringworm (stronger fumes, will discolor)– Low toxicity– CHEAP!– No cleaning activity
I ti t d b li ht & i tt
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– Inactivated by light & organic matter– Not stable if sits (mix fresh daily)
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Disinfectants for Home
• Quaternary Ammonium Products(Roccal, Simple Green, A-33, Kennel-Sol)( , p , , )– Moderate inactivation by organic matter– Inactivated by soap/detergent– Stable for the day– Relatively inexpensive– NOT reliable against parvo, calici or ringworm
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g p , g
Disinfectants for Home
• Potassium peroxymonosulfate(Trifectant, Virkon)( , )– Effective against parvo, calici– Not reliable against ringworm– Some detergent activity– Relatively active in the presence of organic matter– Powdered form active for 7 days when mixed
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y– Leaves visible residue– More expensive than bleach
(but still cost effective)
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Things to Avoid• Lysol• Pine-solPine sol• Nolvasan• Alcohol• Hydrogen Peroxide• Mopping Sponges Re-use of rags
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• Mopping, Sponges, Re-use of rags
Good Housekeeping• Laundry practices
– Remove solid wastes before washingg– Bag/contain soiled linens– Use detergent and bleach– Complete wash and rinse cycle– Machine dry or hand in sunshine
P i h d h i h d i l d
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– Practice hand hygiene when doing laundry
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Good Housekeeping• Safety First!
– Cords– Plants– Toxins– Falls– Crushes
C
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– Cars– People safety/bites
Animals in Your Care1. Environmental Health 2. Physical Health2. Physical Health
– Risk assessmento Intake Exam
– Risk reductiono Vaccinationo Parasite control
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o Parasite controlo Nutrition
3. Emotional Health
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Risk Assessment• Intake examination
– Check for all signs of injury– Check for all signs of infectious diseases
• Recordkeeping– Use a standardized form– Normal/abnormal physical exam findings– Animal description/ID
B d ( t t t ) f l t d f d
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o Breed, sex (neuter status), age for lost and found– Track behavior status– Track treatments
Risk Assessment• Weekly – Biweekly recorded evaluations
– Check for all signs of injuryg j y– Check for all signs of infectious diseases– Weight checks– Behavior checks– Treatment updates
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Risk Reduction - Vaccination• One of the MOST important wellness tools• Many considerations:Many considerations:
– Which animals to vaccinate?– When should vaccines and boosters be given?– What type of vaccines to use?
o MLV, Killed, RecombinantWh f i i ?
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– What route of vaccination?o Intranasal, Subcutaneous
– Are there risks?
Risk Reduction - Vaccination
• Shelter situations are unique– Many animals are naïve on entryMany animals are naïve on entry– Vaccination may protect against fatal diseases– Vaccines can fail for many reasons – only one part of infection control!
• Different protocols than owned pets
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• Risk:benefit ratio must be weighed• Tailored strategies are STILL important• No single protocol works for every program
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Risk Reduction - Vaccination• What are vaccines?
– Triggers of • What vaccines aren’t!
– Instant immunity for ggprotective immune responses
– Ways of limiting overall disease and severity in a
yevery animal
– Antibodies– Guaranteed disease protection
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population
Risk Reduction - Vaccination• Strategies
– Follow AAHA/AAFP shelter guidelines1
– Vaccinate on intakeVaccinate on intake– Vaccinate nearly every animal – Proper handling
o Keep refrigerated until useo Avoid sunlighto Do not split doseso Mix w/ proper diluent
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o Give by proper routeo Clean up spills
– MLV vs. killed products
•1 www.aahanet.org/PublicDocuments/VaccineGuidelines06Revised.pdf• http://www.catvets.com/professionals/guidelines/publications/?Id=176
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AAHA 2006 Canine Shelter Guidelines• “Core” vaccines
– Recommended at intakeP & Ad io Parvo & Adeno virus− SQ MLV
o Distemper virus− SQ MLV
o Parainfluenza virus− SQ or IN
o Bordetella bronchisepticaSQ or IN
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− SQ or IN
– Recommended at exit (or intake for some)o Rabies
AAHA 2006 Canine Shelter Guidelines
• Other– Boost adults in 2 weeks– Pups start @ 4-6 wks
o q2wks until 16 wks– Vx mildly ill or injured– Vx nursing
Weigh risks in pregnant
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– Weigh risks in pregnant
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AAFP 2006 Feline Shelter Guidelines
• “Core” vaccines– Intake
o Panleukopenia− SQ MLV
o Herpes & calici virus− IN +/or SQ MLV
– Exit (or intake for some)o RabiesSpecial circumstances
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– Special circumstanceso FeLVo Bordetellao C. felis
AAFP 2006 Feline Shelter Guidelines
• Other– Boost adults in 2 weeks– Kittens start @ 4-6 weeks
o q2-4 wks until 16 wks– Vx mildly ill and injured– Vx nursing
Weigh risks in pregnant
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– Weigh risks in pregnant– Use inactivated for retrovirus + cats
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Risk Reduction - Parasite Control
• Not always apparent• Uncomfortable for host• Uncomfortable for host• Often contagious• Can spread to humans• Parasitized animals are immunocompromised
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Risk Reduction – Parasite Control• Strategies
– Deworm all animals routinely regardless of fecals– Follow CDC and CAPC guidelines1
– On intake then q2wks until 3mos, monthly until 6 months– Cover main zoonoses
o Hooks, roundso Pyrantel, Drontal Plus, Panacur
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•1http://www.cdc.gov• http://www.capcvet.org
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Risk Reduction – Parasite Control• Exams and tailored treatment for symptomatic• Treat for Coccidia and Giardia if suspected
– Bathe animals as part of treatment– Keep environment dry and clean
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Risk Reduction – Parasite Control• External parasites
– Consider routine use of topspot productsp p p– Recheck and retreat heavily infested animals– Don’t forget to treat the environment
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Risk Reduction - Nutrition
• Proper nutrition improves immunity & healthhealth• Body condition appropriate
– Body condition score scaling• Life stage appropriate
– Juveniles need several meals/day
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y• AAFCO approved brands
– Use donations with care
Risk Reduction - Nutrition• Strategies
– Feed measured quantitiesq– Use a written guide by weight– Interval feed– Positive reward feeding for enrichment– Chewing = decreased stress, better health
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Risk Reduction - Emotional Health• Stress is the sum of the biological reactions to any adverse stimulus, physical, mental or y p yemotional, internal or external, that tends to disturb the homeostasis of an organism
• Stress is inevitable in shelters but every ff h ld b d i i i i
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effort should be made to minimize it
Risk Reduction - Stress1. Physical stress
– Malnutrition– Injury
2. Environmental stress– Hot/cold– Wet/humid
3. Emotional stress– Fear– Pain– Parasite infestation
– Disease– Poor ventilation– Noise– Overcrowding
Pain– Boredom– Depression– Anxiety
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Facts About Stress
• Stress induced symptoms are difficult to distinguish from infectious diseasedistinguish from infectious disease– Physiological
o Anorexiao Depressiono Vomiting/diarrhea
– Behavioral
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o Aggressiono Withdrawalo Stereotypies
Risk Reduction - Stress• Strategies
– Provide physical health carep yo Vx, Nutrition, Parasite control…
– Maintain environmental conditionso Turn off lighting at night, sunlight, fresh airo Minimize odor/fumeso Decrease noise – soft music, cat fountains
Time procedures routinely (feeding/cleaning)
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o Time procedures routinely (feeding/cleaning)– Enrichment
o House compatible animals/littermateso Beddingo Toys
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Risk Reduction - Stress• Overcrowding
– Stressful to people & animalsp p– Fewer resources per animal– Increases disease transmission– Does NOT save lives
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Before MORE Animals Enter a Home
• What is the potential risk:benefit?
• Assume the new animals are infectious– Can the current animals be kept separate?– Will resources support the population?
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pp p p– What if disease is introduced to all?
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Adoption Time!• Set new owners up to succeed
– Individual animal’s health informationo Medical records & veterinary contacto Ongoing physical and behavioral wellness needso Infectious disease risks
– General informationo Adoption
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po Wellness o Infection control in their home!
Summary• Shelter animals are at high risk for illness• Plans for infection control should start beforePlans for infection control should start before animals enter a home• Education and protection of human health is an important component of infection control• Keeping animals well involves maintaining
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their environmental, physical and emotional health care• Infection control and wellness plans save lives!
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Thank You For All You Do!
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ASPCApro – Shelter MedicineASPCApro – Foster Care
www.ASPCApro.org
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